As pain, be it acute or chronic, can severely restrict quality of life, humanity has been striving for pain relief since year zero. Painkillers (analgesics) are thus one of the most frequently ingested forms of medication. For that reason, knowledge of the effects and side effects of analgesics is essential during your medical studies and later work as a physician. The following article shall provide you with an overview of the most important painkillers.

00:00
Commonly used drugs as well are
non-steroidal anti-inflammatories.
00:05
The great grandfather of all these drugs
is aspirin, ASA. The newer drugs tend tobe either relatively short acting
and low potency like ibuprofen,or they can be very long acting
and have very profound effects onthe cyclooxygenase enzymes,
COX-1 and COX-2, and reducethe production of prostaglandins, which are
present in inflamed tissues. So,the reduction in inflammation reduces pain,
so that's where they become analgesics.
00:41
They also reduce the recruitment of leukocytes,
white blood cells, which produce inflammatorymediators. So they both
go in and help moderateinflammation and prevent further inflammation
from forming. So, side-effectsof non-steroidals are not inconsequential
either, unfortunately.
01:05
And gastric hemorrhage is still a relatively common
event in people who were taking high doses of thesedrugs. They're very irritating
to the gastric mucosa. In addition,they interfere with platelet function, so they
interfere with clotting. So once bleeding starts,they tend to cause a lot of bleeding.
They also cause renal toxicity. Andone of the more common causes of renal failure
in the western world is excessive use of non-steroidalanti-inflammatory agents. Specific drugs,
ASA, even though it's the originalnon-steroidal, has virtually no effect on the kidney,
but it has lots of effect, bad, on the stomach.
01:47
Acetaminophen, which falls into the same
family, interestingly has virtuallyno anti-inflammatory effect. It
does not cause bleeding, it doesnot have any negative effect on the kidney. But it's unfortunately
becoming one of the commonest reasonsfor liver transplant in North America, as people
overdose on it or take too much for theirpain management, because it's directly toxic to the liver.
So, as I already mentioned, Ibuprofen is relatively shortacting. Other drugs such as Naproxen,
or Ketorolac, or Diclofenac arelonger lasting. They all have the same
negative renal and gastric effects,but they also likely have cardiac effects that we
haven't really been aware of in the past. And wedidn't really learn much about this until a class
of drugs called COX-2 inhibitors were introduced,with the expectation of fewer side effects,
particularly gastric, but also less bleeding.
02:47
And this was, these drugs were pushed
incredibly aggressively, particularly to orthopedicsurgeons, and were extremely widely used.
The one that you may have heard of was Vioxx.
02:59
And, after about five years of use,
it was discovered that the incidenceof ischemic cardiac events, myocardial infarctions
and death, in people taking these drugswas quite high. And they were finally stopped.
And the interesting thing from a historical perspectiveis that one of the drug, not regulatory
bodies, but examination bodies atmy own university, actually published the problem with,
the potential problem with cardiac diseaseyears in advance of this drug being taken, these drugs
being taken off the market, and it was largely ignored.

About the Lecture

The lecture Non-steroidal Anti-inflammatories – Analgesics, Case Reports and Obstetrical Pain by Brian Warriner, MD is from the course Anesthesia.

USMLE™ is a joint program of the Federation of State Medical Boards
(FSMB®) and National Board of Medical Examiners (NBME®). MCAT is a registered
trademark of the Association of American Medical Colleges (AAMC).
None of the trademark holders are endorsed by nor affiliated with Lecturio.